TEJAL R MODI Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****27

License Status

ACTIVE

Business

First Name

TEJAL

Middle

Last Name

MODI

Business Name

TEJAL R MODI

Original Issue Date

10/12/2006

Effective Date

12/31/2025

Expiration Date

03/01/2028

City

CRYSTAL LAKE

State

Zip

60014

County

COOK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

12/31/2025